The disease anamnesis (Anamnesis morbi)

The disease beginning; description of the process in chronological order with indication of change dynamics in the focus of affections; any treatment in the past, and the reasons (causes) that are connected with the exacerbation, as to the patient’s point of view; the hospitalization causes.

Most patients with skin disease are seen, and treatment prescribed, in the family doctor's surgery or in a hospital out-patient department. Only a small proportion require admission. It is therefore even more important than in other specialties to ask the patient all the possibly important questions in an orderly and logical work. Questions forgotten cannot easily be answered until the next general outline of useful points to remember in dermatological history-taking include:

1. How long have any skin lesions been present? Patients will often only tell you how long they have had the lesions which are currently worrying them and will not begin at the beginning of their problem.

2. Where did the problem first appear? As above, patients will often ask you for help only with the patch of psoriasis on their scalp, and will not, unless prompted, tell you about the large plaque on their back.

3. Are there any symptoms? These are usually itch and/or pain.

History taking should include; where and when the problem started, symptoms (severe itch, mild itch, pain), medicaments, general medical history, occupation and recreation, travel, family and household contacts, and the patient's own views in the likely cause.

The patient's thoughts on the cause of the problem. Ask the patient what he or she thinks is wrong and what has caused it. The answer to this question may give you a clue to the diagnosis, and perhaps even more important, may also reveal unexpected theories and worries. Patients may tell you that they believe diet is the cause, and may have tried out unusual and sometimes dangerous dietary changes for themselves or their children. Give the patient time to tell you about this towards the end of the history-taking when he/she is relatively relaxed and you have gained his/her confidence.

These questions should be asked personally in a quiet and unhurried atmosphere where the conversation cannot be overheard by other patients.

Remember that almost all patients are embarrassed by skin disease, and many are ashamed of their appearance. Treat them with understanding and sympathy, and they will remember their visits to you with gratitude, even if you cannot yet provide a cure.

Travel. Ask about holidays, professional travel, and, in the case of those not of UK origin, about visits to or from relatives in their native country. Ask about visits of a relative from overseas, and ask about details of air travel, including refuelling stops. Nowadays many people, including medical students, travel long distances on holiday or to do elective periods of study.

Family and household contact history. Many patients with skin disease are confused over infection and genetic transmission. Ask about first-degree relatives as this can be a clue in conditions such as ichthyoses, and also ask about household contacts as these are not always family members. Infections such as scabies may infect both relatives and others with whom the patient is in close contact.

Topical and oral medicament history. Ask the patient carefully about these. To many elderly patients 'medicines' are not drugs, and the question 'What drugs are you on? ' does not always result in an accurate response. Begin by asking about any medicine taken on prescription, then move on to preparations bought over the counter in the chemist or health food shop. An increasing number of patients are using alternative therapy in the form of herbal and homeopathic preparations, and may be reluctant to reveal this in a 'conventional medicine' setting without some coaxing: Ask specifically about sleeping pills, tablets for headaches or other aches and pains, and laxatives.

In general hospitals, the commonest reason for a request for a dermatologist to see a patient in another ward is because of a suspected adverse drug reaction. Be very sure you have access to a full list of everything given in the past 2-3 weeks, not just the treatment being used on the day you see the patient.

⇐ Предыдущая1234Следующая ⇒

Поделиться: